Heparin-free veno-arterial extracorporeal membrane oxygenation in lung transplantation: a retrospective cohort study.

BACKGROUND: In lung transplantation (LTx) surgery, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can provide mechanical circulatory support to patients with cardiopulmonary failure. However, the use of heparin in the administration of ECMO can increase blood loss during LTx. This study aimed to evaluate the safety of heparin-free V-A ECMO strategies. METHODS: From September 2019 to April 2022, patients who underwent lung transplantation at the First Affiliated Hospital of Guangzhou Medical University were retrospectively reviewed. A total of 229 patients were included, including 117 patients in the ECMO group and 112 in the non-ECMO group. RESULT: There was no significant difference in the incidence of thrombus events and bleeding requiring reoperation between the two groups. The in-hospital survival rate after single lung transplantation (SLTx) was 81.08%in the ECMO group and 85.14% in the Non-ECMO group, (P = 0.585). The in-hospital survival rate after double lung transplantation (DLTx) was 80.00% in the ECMO group and 92.11% in the Non-ECMO groups (P = 0.095). CONCLUSIONS: In conclusion, the findings of this study suggest that the heparin-free V-A ECMO strategy in lung transplantation is a safe approach that does not increase the incidence of perioperative thrombotic events or bleeding requiring reoperation.

Anesthetic management of heart and lung transplantation: analysis of 14 cases in a single center.

Background: Aggressive management of heart and lung transplant (HLTx) requires a team of specialists with dedicated expert to improve long-term outcomes. This study aimed to summarize practical experiences of anesthetic management in HLTx operations. Methods: This study retrospectively analyzed the anesthesia-related clinical records of 14 cases of HLTx performed from September 2015 to October 2019. Preoperative diagnoses included congenital heart disease with pulmonary arterial hypertension, idiopathic pulmonary arterial hypertension with right heart failure, end-stage cor pulmonale, dilated cardiomyopathy, end-stage heart failure with pulmonary arterial hypertension, congenital heart disease, and lung transplant failure. All recipients received intravenous-inhalation general anesthesia with single-lumen endotracheal intubation, Swan-Ganz catheterization, and transesophageal echocardiography (TEE). Results: All 14 cases of HLTx were completed successfully and the patients were transferred to the intensive care units (ICUs). The postoperative data of the 14 patients were collected from 1 month to 4 years: seven cases survived the first year, four cases died in the short term (within 30 days), and one case died within 24 h. As at the end of November 2019, eight cases were reported dead (the longest survival was 2 years 1 month and 22 days). Four cases used extracorporeal membrane oxygenation (ECMO) for cardiopulmonary support. Conclusions: The success of the HLTx was attributed to the joint efforts of the entire transplantation team. The anesthesiology team was required for experiences in anesthesia for HLTx. The key to anesthesia management was the in-depth participation in preoperative discussions and assessments. Preventing the exacerbation of right heart failure and pulmonary arterial hypertension is critical during the induction of anesthesia. Regulation and support are crucial from the withdrawal of cardiopulmonary bypass (CPB) to within 1 h of the circulation and respiratory functions undertaken independently by the donor heart and lungs.

Spontaneous ventilation anaesthesia: total intravenous anaesthesia with local anaesthesia or thoracic epidural anaesthesia for thoracoscopic bullectomy.

OBJECTIVES: At present, few data exist regarding the comparisons of perioperative outcomes and recurrence of spontaneous ventilation (SV) video-assisted thoracic surgery (VATS) bullectomy using total intravenous anaesthesia (TIVA) with local anaesthesia (LA) or thoracic epidural anaesthesia (TEA). We evaluated the feasibility and safety of TIVA with LA in the management of primary spontaneous pneumothorax (PSP). METHODS: We conducted a single-institution retrospective analysis of patients undergoing VATS bullectomy between July 2011 and May 2015; 240 patients were included for analysis. Preoperative, intraoperative and postoperative variables of patients undergoing VATS bullectomy using TIVA-TEA (n = 140) were compared with those using TIVA-LA (n = 100). RESULTS: Baseline demographics were similar between groups. No patients in either group required conversion to thoracotomy. Three patients (TIVA-TEA: 2; TIVA-LA: 1) required conversion to intubated general anaesthesia. Both groups had comparable surgical duration, estimated blood loss, peak EtCO2 and lowest intraoperative SpO2 level. Postoperatively, thoracic drainage volume, duration of chest tube drainage and hospitalization cost did not differ between groups. The incidence of postoperative complications between groups was not significant (2% for TIVA-TEA vs 2% for TIVA-LA, P = 1.00). Pneumothorax recurrence rate was 3% in TIVA-TEA cases (n = 4) and 2% in TIVA-LA cases (n = 2). CONCLUSIONS: SV-VATS bullectomy using TIVA with LA or TEA is technically feasible and safe. Both groups have comparable short-term outcomes and recurrence rates; TIVA-LA seems a valid alternative to TIVA-TEA for the surgical management of PSP under SV.

[Effects of small needle-knife comprehensive therapy on pain and lumbar flexion range in the chronic nonspecific low back pain patient].

OBJECTIVE: To observe therapeutic effect of small needle-knife comprehensive therapy on pain and lumbar flexion range in the chronic nonspecific low back pain patient. METHODS: Three hundred and five cases were randomly divided into a needle-knife group of 153 cases and a physiotherapy group of 152 cases. The needle-knife group were treated with small needle-knife releasing therapy, blocking and functional training. The physiotherapy group were treated with ultra-short wave, modulated medium frequency current, massage and functional training. Pain was assessed by visual analogue scale (VAS) and the lumbar flexion range was determined before and after treatment. RESULTS: After treatment, the pain and the lumbar flexion range were significantly improved in the two groups; and after treatment, the VAS score and the lumbar flexion range were (1.60 +/- 0.38) points and (65.76 +/- 15.11) cm in the needle-knife group and (4.59 +/- 1.09) points and (53.74 +/- 15.13) cm in the physiotherapy group, respectively, the needle-knife group being significantly better than the physiotherapy group (P < 0.01). Follow-up survey of 6-36 months showed that the VAS score and the lumbar flexion range in the needle-knife group were superior to those in the physiotherapy group. CONCLUSION: Small needle-knife comprehensive therapy can significantly improve pain and lumbar flexion range in the chronic nonspecific low back pain patient, with a stable long-term therapeutic effect.

[The effect of smoke and alcohol abuse to voice].

OBJECTIVE: To explore parameters which can discriminate the voice of smoke and alcohol abuse and healthy voice by contrasting the voice parameters of two groups, and to study the pathogenic mechanism of the adverse effect of smoke and alcohol abuse to voice by the change of parameters. METHOD: Selecting 33 male subjects with smoke and alcohol abuse, and selecting other 33 healthy male subjects with no smoking and alcohol abuse and no ENT disease as control, randomly. Assessed by "vocal assessment", each subject was required to phonate /ae/ for 3 s, voice parameters including F0, Jitter, NNE and CQ were collected for multivariate analysis. RESULT: There were significant difference between smoke and alcohol abuse group and controlled group on the voice parameters (P < 0.01). F0 of the former is significantly lower than that of the latter (P < 0.01). Jitter of the former is significantly larger than that of the latter (P < 0.01). NNE of the former is significantly larger than that of the latter. CQ of the former is significantly smaller than that of the latter (P < 0.01). CONCLUSION: Smoke and alcohol abuse had the adverse effect on the human voice. Both theory and experiment analysis were useful methods of selecting sensitive parameters. F0, Jitter, NNE and CQ were effect parameters which can reflect the voice characteristic of smoke and alcohol abuse, and can be used to monitor the effect of therapy for this kind of pathological voice.

[Relationship between voice acoustic parameters and vocal quality].

OBJECTIVE: This research is aimed at looking for the effect acoustic parameters of voice quality through the Spearman correlation analysis between auditory-perceptual judgment of voice quality and synthesized acoustic parameters. METHOD: Thirty-six vowel samples of /ae/ synthesized with six acoustic parameters (F0, Jitter, Shimmer, NNE, Spectral tilt, Formant Flutter), each parameter dimension included 25% coped ones, altogether 45 samples. Then give the serial number to each sample after their order is randomized. The sound samples were given by computer, intensity was fixed at 70dB. Eight famous ENT doctors participated in the task of auditory-perceptual judgment. Give the grades to G, R, B, resulting that there are high inherent consistency (P<0.01). Then do the Spearman correlation analysis with each acoustic parameter respectively. RESULT: There are significant correlation between the auditory-perception (G, R, B) and Jitter, Shimmer and NNE (P<0.01). CONCLUSION: Jitter, Shimmer and NNE are effect acoustic parameters reflecting the voice quality. Human voice is multidimensional. The combination the auditory-perceptual (G, R, B) judgment with acoustic analysis is the best method of assessing the voice quality.

[Method for determination of RE2O3 by X-ray fluorescence spectrometry].

A simple and rapid quantitative method for determining RE2O3 in rare earth oxide by X-ray fluorescence spectrometry was developed. A new method for manufacturing sample was brought up. The sample pedestal plate was lathed with polytetrafluoroethylene. A filter paper located in the sample pedestal plate was used to absorb 1 mL analytical solution, dried under infrared lamp or in stove and measured by X-ray fluorescence spectrometry with a 6 microm covering film. No remainder was detected in the sample pedestal plate. Vanadium was confirmed as the internal standard to compensate the influence of the location of absorbing filter paper within the sample pedestal plate, the analytical range was large, the accuracy and precision were satisfactory, the results agreed with other methods, and the method has been used in routine analyses for ten years. Also the method for manufacturing sample has been applied to a variety of materials.

[Therapeutic effect of compositive rehabilitation on lumber disc herniation].

OBJECTIVE: To observe the curative effect of different physical rehabilitation techniques on patients with lumbar disc herniation. METHODS: Eighty-four patients were randomly divided into Group A, Group B and Group C. Group A were treated with the computerized pelvis traction and ultrashort wave, Group B were treated with the computerized pelvis traction only, while Groups C were treated with the computerized pelvis traction, the ultrashort wave and the traditional Chinese medicine iontophoresis. The outcome was measured with the Japanese Orthopaedics Association Score (JOA score) about lower back pain (LBP). RESULTS: Compared with before the treatment, the JOA score of all the 3 groups increase markedly after the treatment (P<0.001). Compared with group B, the JOA score of Groups A and Group C significantly increased (P<0.05). Compared with Group A, the JOA score in Group C significantly increased (P<0.05). CONCLUSION: The curative effect of comprehensive rehabilitation on lumbar disc herniation is better than that of the single rehabilitation.

Clinicopathologic features and results of transcatheter arterial chemoembolization for osteosarcoma.

PURPOSE: To evaluate the effect of transcatheter arterial chemoembolization (TACE) for osteosarcoma and to describe the clinicopathologic features produced by TACE as well as the effect of different embolic materials. METHODS: From January 1998 to December 2003, preoperative TACE was carried out in 32 patients. The preoperative and postoperative clinical response, levels of alkaline phosphatase (AKP), leukocyte count, and clinicopathologic features were recorded. We also compared the effect of different embolic materials: adriblastine gelatin microspheres, anhydrous alcohol, common bletilla tuber, and gelatin sponge particles. RESULTS: The levels of AKP were significantly decreased after treatment (p < 0.05), but there was no significant difference in the leukocyte count. Large areas of necrosis were found histologically within 85.5% tumors after TACE. Embolic agents such as adriblastine microspheres, anhydrous alcohol, and common bletilla tuber have better clinical effects than gelatin sponge particles, but there was no significant difference among the first three embolic materials. After treatment, no serious complications were noted. During successful follow-up for 86 months, the survival rate after TACE at 1, 2, and 5 years was 95.5%, 72%, and 42% respectively. CONCLUSION: TACE accelerated tumor necrosis and shrank the tumor volume, thus making adequate tumor resection possible. The optimal time to operate is 10-14 days after TACE. TACE in combination with limb salvage surgery and postoperative periodical chemotherapy may be beneficial for increasing local control rates.

[Epidemiologic research on the clinical features of patients with cervical spondylosis].

OBJECTIVE: To investigate the clinical features of patients with cervical spondylosis. METHODS: Questionnaires were provided and X rays were examined in 1 009 people with different occupations, ages, and sexes. RESULTS: All the patients were diagnozed as cervical spondylosis. Of them, cadres occupied 78.83%, technologists made up 74.21%, and accountants 58.70%; nervous and long-time working people accounted for 59.75%; high and middle pillow-lovers occupied 80.03%. Imaging features: most of the degenerative changes of cervical spine were located between C5-6 (40.79%), C4-5 (26.29%), and C6-7 (18.20%). Patients with vertebral osteophyte were 65.75%, intervertebral space narrow 36.87%, intervertebral foramen narrow 29.19%, and physiological curve change 31.03%. CONCLUSION: This epidemiologic investigation is important, which can further understand the cause of cervical spondyiosis, and strengthen its prevention and treatment.